What Individuals Need to Know

Health care reform requires that:

  • Most people buy health insurance or pay a fine.
  • You can’t be denied coverage if you have a serious health condition.
  • Premiums for Affordable Care Act (ACA) plans aren’t be based on your health status. ACA premiums are based on your age and may be adjusted for tobacco use.

How much is the fine?

The Internal Revenue Service will fine people who don’t have insurance:

  • 2015: $325 or 2 percent of income, whichever is greater
  • 2016: $695 or 2.5 percent of income, whichever is greater
  • Beginning in 2017, the penalties will be increased by the cost-of-living adjustment.

Use this calculator to estimate your tax penalty fine.

Is anyone excluded from paying a fine?

There are a few exceptions to the penalty, including:

  • Religious reasons
  • Not present in the United States
  • In prison
  • Not able to pay for coverage that is more than 8 percent of the household income
  • An income that is below 100 percent of the poverty level
  • Having a hardship waiver
  • Not covered for less than three months during the year

Learn more at healthcare.gov.

HMSA Plans for Individuals and Families

Good health care is within your reach. Discover an HMSA plan that best fits your needs and lifestyle.

If you buy health insurance on your own

We’ll help you choose a plan that complies with health care reform and fits your health needs and budget. You’ll have the option to:

  • Come straight to us. We can help you choose an ACA plan that better fits your health and budget situation. We know you and we’re here to help.
  • Use the marketplace. You can buy an HMSA health plan on healthcare.gov, the federal health insurance marketplace. Depending on your income, you may qualify for financial help in the marketplace to pay for your health insurance premiums and out-of-pocket costs.

If you’re on Medicare or QUEST Integration, these plans are not available in the marketplace. Contact us to enroll in HMSA Akamai Advantage or HMSA QUEST Integration.

Benefits have changed

ACA plans offer these 10 essential health benefits:

  1. Prescription drugs
  2. Ambulance service
  3. Emergency care
  4. Hospitalization
  5. Laboratory services
  1. Maternity and newborn care
  2. Mental health and substance use services
  3. Pediatric oral and vision services
  4. Rehabilitation and habilitative services
  5. Services for preventive care, wellness, and chronic disease management

Changes to Health Plans Already in Place

Keiki. Kids can’t be turned down for coverage even if they have medical conditions like asthma.

Young adults. If you haven’t turned 26 yet, you can be covered under your parent’s family health plan if their plan offers dependent coverage.

Women. You can get some preventive health care services at no charge to you, including:

  • Well-woman exams
  • Mammograms
  • Breast-feeding support and counseling

All adults. You can get preventive screenings and immunizations at no charge to you, including:

  • Blood pressure screenings
  • Cholesterol screenings
  • Colonoscopies
  • HIV screening and counseling

See a complete list of screenings and immunizations that HMSA covers: Health Care Reform Coverage for Preventive Health Benefits. Some exceptions may apply to you. Check with your doctor or us for details.

This information is based on HMSA’s review of the Affordable Care Act (ACA). This overview is intended for educational purposes only and should not be used as tax, legal, or compliance advice.